PSY 275 Week 3 Depressive and Bipolar Disorders Example

Low Mood or Something More? Telling Depression From Bipolar Disorder in a High School Teacher

[Student Name]

University of Phoenix

PSY/275: Introduction to Abnormal Psychology

Week 3 Assignment

[Instructor Name]

[Date]

The teacher and her history are composites written for a model paper; research findings come from the sources listed.

Mood disorders involve disturbances in emotion that are severe, lasting and impairing. Depressive disorders involve periods of low mood or loss of interest; bipolar disorders also involve periods of abnormally elevated or irritable mood. Telling them apart matters because treatment differs, sometimes sharply. This paper works through a composite case to show how clinicians make that distinction.

The Case

Carmen is forty-one and has taught history at a public high school in Tucson, Arizona, for fifteen years. Her divorce became final two months ago. For the past six weeks she has felt empty most of the day, has stopped coaching the debate team she loved, sleeps ten hours a night yet wakes tired, has gained twelve pounds and struggles to concentrate on grading. She has missed six days of work and stopped answering calls from friends. She describes herself as a failure and says she sometimes wonders whether her kids would do better if she were gone, though she has no plan to harm herself.

Matching Symptoms to Criteria

A major depressive episode means at least two full weeks in which low mood or lost interest is present plus additional symptoms, for a total of five or more, such as changes in sleep or appetite, fatigue, feelings of worthlessness, poor concentration and thoughts of death, causing significant distress or impairment. Carmen reports depressed mood, loss of interest, oversleeping, weight gain, fatigue, worthlessness, trouble concentrating and thoughts of death without a plan, lasting six weeks and affecting her work. She meets criteria for a major depressive episode.

Addressing Suicide Risk

Carmen's belief that her kids would do better if she were gone requires careful attention. A clinician would ask directly about thoughts of suicide, plans, intent, access to means and past attempts, and would develop a safety plan with her. Asking about suicide does not increase risk; it opens the door to help. Her lack of a plan and her strong connection to her children are protective factors, but her risk would be monitored throughout treatment.

The Question of Past Highs

Before concluding that Carmen has major depressive disorder, a clinician would ask about past periods of elevated mood. Carmen recalls several stretches in her thirties, each lasting about four days, when she slept four hours a night without feeling tired, felt unusually confident, talked rapidly, started several projects at once and spent money impulsively on a vacation she could not afford. Friends noticed the change, but it did not cause serious problems at work or lead to hospitalization.

These episodes may have been hypomanic: a distinct period of elevated mood and increased energy lasting at least four days, noticeable to others but short of the severity that would seriously impair functioning or require a hospital stay. If confirmed, a history of hypomania together with a major depressive episode would indicate bipolar II disorder rather than major depressive disorder. Bipolar I would require at least one full manic episode, which is more severe and impairing.

Carmen came in for depression; the most important question in the interview was about the weeks when she felt better than ever.

Why the Distinction Matters

Treatment differs. In bipolar disorder, antidepressants used alone may be less effective and can, in some people, trigger mood elevation or faster cycling, so mood stabilizers are central. Psychotherapy approaches also differ in their focus, with bipolar treatment emphasizing regular routines, medication adherence and early warning signs.

Persistent Depressive Disorder and Other Possibilities

The clinician would also consider persistent depressive disorder, a milder but chronic depressed mood lasting at least two years. Carmen's low mood began six weeks ago and her earlier functioning was strong, so this diagnosis does not fit. Grief and adjustment to the divorce could explain some sadness, but the number and severity of her symptoms and their effect on work go beyond a typical adjustment. Substance use and medical conditions would be ruled out through questions and lab tests.

Contributing Factors

Kendler et al. (1999) studied female twin pairs and found that a severe stressor such as divorce made the onset of depression in the next month far more likely, and that this association held even after accounting for genetic and family factors, supporting a causal role for some events. Carmen's divorce fits this pattern as a likely trigger. Biological vulnerability matters too; mood disorders run in families, and bipolar disorder is among the most heritable psychological conditions. Cognitive factors, such as Carmen's belief that the divorce proves she is a failure, can deepen and maintain depression.

Treatment Evidence

Cuijpers et al. (2013) combined randomized trials of cognitive behavioral therapy for adult depression in a meta-analysis and found it clearly more effective than control conditions and comparable to other psychotherapies and to antidepressant medication, with combined treatment often helpful. If Carmen's diagnosis is major depressive disorder, cognitive behavioral therapy, with or without an antidepressant, would be well supported.

Geddes and Miklowitz (2013) reviewed treatment of bipolar disorder and described mood stabilizers such as lithium as a foundation of long-term care, along with specific psychotherapies that address routines, family communication and recognition of early warning signs. If bipolar II is confirmed, Carmen's treatment would follow this approach.

A Next Step for Carmen

The clinician would complete a structured interview about her mood history, ask permission to speak with a close friend who remembers the high periods, check for medical causes such as thyroid problems and coordinate with a psychiatrist about medication. Meanwhile, therapy can begin addressing her self-blame, her withdrawal from activities she once enjoyed and a safety plan. Returning gradually to coaching debate would rebuild meaningful activity, an approach therapists call behavioral activation.

Conclusion

Carmen meets criteria for a major depressive episode triggered by a painful divorce, but her history of brief high-energy periods raises the possibility of bipolar II disorder. Careful history taking, attention to suicide risk and treatment matched to the diagnosis, supported by research on psychotherapy and on bipolar care, give her the best chance of recovery.

References

Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58(7), 376-385. https://doi.org/10.1177/070674371305800702

Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682. https://doi.org/10.1016/S0140-6736(13)60857-0

Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156(6), 837-841. https://doi.org/10.1176/ajp.156.6.837